Information Collection

NHSC Recruitment and Retention Assistance Application

IC 6469 under ICR 201108-0915-001 · OMB 0915-0230.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0915-0230 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
NHSC Site Application_Users Guide_07252011.zip	Instruction
1 NHSC Site Application NHSC Site Application_screenshots_07252011.doc	Form

IC Title:

NHSC Recruitment and Retention Assistance Application

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction			NHSC Site Application_Users Guide_07252011.zip		Yes	No	Printable Only
Form	1	NHSC Site Application	NHSC Site Application_screenshots_07252011.doc		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 3,000

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	3,000	100	2,900
Annual IC Time Burden (Hours)	1,500	50	1,450
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.